Medical and Surgical Nursing

Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
B.

C.
D.

E.

MEDICAL AND SURGICAL NURSING

Genito-Urinary Tract Disorder
Lecturer: Mark Fredderick R. Abejo RN,MAN
________________________________________________

Structure
1. Renal pelvis
2. Renal colic
3. Renal medulla
Nephron glomerulus
Functions
1. Urine formation
2. Regulates BP
Urine Formation (Normal GFR: 125 ml of blood is
filtered in the glomerulus per minute)
1. Filtration
2. Tubular Reabsorption 124 ml of ultrafiltrates are
reabsorbed back into the blood
3. Tubular Secretion 1 ml excreted in the urine; of
total cardiac output is received by kidneys

II. Ureters 20-30 mm long serves as a passageway of urine

OVERVIEW OF THE STRUCTURE AND FUNCTION OF
THE GENITO-URINARY TRACT
-

Promotes excretion of nitrogenous waste products

Maintain fluid electrolytes and acid-base balance

III. Bladder
A. Located behind the symphysis pubis
B. Made up of muscular and elastic tissues distensible
reservoir of urine
C. Max: 1, 200 -1,800 ml of urine
D. Initiates urination: 250-500 cc ml
E. Normal urine:
1. amber, aromatic, turbid/clear, pH 4-8
2. spec gravity: 1.015-1.030
3. WBC, CHON none
4. (-) E. coli
5. mucus threads few
6. (-) amorphous urates
IV. Urethra
A. Serves as a passageway for urine, vaginal/seminal fluids
B. Length
1. F: 3-5 cm or 1-1/2 inches
2. M: 20 cm or 8 inches
C. Catheter
1. Pedia: 8-10 fr
2. F: 12-14 fr
3. M: 16-18 fr
URINARY TRACT INFECTIONS
I.

I.

MS

Kidneys
A. Location a pair of bean shaped organs located
retroperitoneally (behind peritoneum) on either side of
the verbral column

CYSTITIS inflammation of bladder caused by bacterial

infection

A.

PREDISPOSING FACTORS
1. High risk: women
2. Microbial Invasion (E. Coli)
3. Increased estrogen levels, estrogen therapy
4. Sexual intercourse
Abejo

Medical and Surgical Nursing

Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
5.
6.
7.
8.
B.

S/SX
1. Urinary frequency and urgency
2. Flank pain
3. Fever, chills, anorexia, generalized body malaise
4. Dysuria burning upon urination
5. Hematuria

C.

DX
1. Urine culture and sensitivity

(+) E. Coli 90%

2. Urinalysis

Increased WBC

Increased CHON

Increased pus cells

D.

NSG MGMT
1. Forced fluids (2-3 L/d)
2. Provide warm sitz bath to promote comfort
3. Provide acid-ash diet: cranberries, grape juice,
plums

4.
5.

6.

MS

Urinary retention
Incontinence
Urinary obstruction
Poor perineal hygiene

Monitor for gross hematuria, color, odor of urine

Administer meds as ordered

Systemic antibiotics
Penicillins
Cephalosporins
(SE:
nephrotoxicity,
hepatotoxicity)
Tetracycline
(staining
of
teeth,
photosensitivity)

Sulfonamides
Co-trimoxazole (Bactrim)
Gantricin
Sulfisoxazole

Urinary antiseptics
Nitrofurantoin (Macrodantin)
Furadantoin

Urinary analgesics
Pyridium decreases pain, promotes
relaxation of sphincter
Discharge teaching

Importance of hydration

7.

Void after sexual intercourse

Instruct female client to:
Proper perineal hygiene
Front to back cleaning
Avoid tissue use
Bubble bath
(-) talcum powder, perfume

Prevent complications

Pyelonephritis

II. PYELONEPHRITIS acute or chronic inflammation of

renal pelvis leading to tubular destruction, intestinal abscesses
and renal failure

A.

PREDISPOSING FACTORS
1. Microbial invasion

E. coli

Streptococcus
2. Urinary retention/ stagnation
3. pregnancy
4. DM
5. Exposure to renal toxins/ use of nephrotoxic agents
6. Obesity

B.

S/SX
1. Acute Pyelonephritis

Urinary frequency and urgency

Costovertebral angle pain and tenderness

Fevers and chills, anorexia, general body

malaise

Burning upon urination

Dysuria, nocturia, hematuria

2. Chronic Pyelonephritis

Fatigue and/or weakness

Weight loss

Polyuria

Polydypsia

HPN

C.

DIAGNOSTICS
1. Urine CS: (+) cultured microorganisms (E.coli and
strep)
2. Urinalysis: elevated WBC, CHON, pus cells
3. Cystoscopic exam: (+) urinary obstruction
Abejo

Medical and Surgical Nursing

Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
D.

4.
5.
6.

NURSING MANAGEMENT
1. Provide CBR especially during acute attack
2. Forced fluids
3. Provide an acid ash in the diet
4. Provide warm sitz bath for comfort
5. Administer medications as ordered

Nitrofurantoin
SE: GIT irritation, give with food,
peripheral neuropathy, hemolytic anemia
(initial sx: fever), discoloration of teeth

Urinary analgesics
Pyridium
6. prevent complications

renal failure

7.

8.

III. NEPHROLITHIASIS/UROLITHIASIS formation of

stones elsewhere in the urinary tract

9.

Strain all urine using gauze pad

Warm sitz bath for comfort
Meds as ordered

Narcotic analgesics morphine

Allopurinol (zyloprim)
Provide dietary intake:

If (+) to ca stones: acid ash

If (+) to oxalate stones: alkaline ash (milk,

tea, vegetables)

If (+) to uric acid: avoid purine rich food

like anchovies, legumes, organ meat, nuts
Assist

Litholapoxy surgical removal of 2/3 stone

Nephrectomy removal of kidney

stagnation

Lithotripsy extracorporeal shockwave

No incision, early discharge
Too costly
Stones can recur
Post-op: strain urine
Prevent complications renal failure

IV. ACUTE RENAL FAILURE (ARF) sudden inability of the

kidneys to excrete nitrogenous waste products, leads to
azotemia
A.

MS

A.

TYPES OF STONES
1. calcium
2. oxalate
3. uric acid

B.

PREDISPOSING FACTORS
1. diet high in calcium and oxalate
2. hereditary (like gout)
3. hyperparathyroidism (Hypercalcemia)
4. obesity
5. sedentary lifestyle

C.

S/SX
1. Renal colic
2. Cool, moist skin
3. Burning upon urination
4. Dysuria, Nocturia
5. Hematuria

D.

DIAGNOSTICS
1. Urinalysis (+) RBC, WBC, Pus cells
2. KUB: reveal site or location of stones
3. Stone analysis: reveals composition of stone
4. Cystoscopic exam: urinary obstruction
5. IVP: reveals obstruction

E.

NURSING MANAGEMENT
1. Forced fluids to prevent further crystallization
2. Alternate warm and cold compress
3. Administer isotonic fluids as ordered

PREDISPOSING FACTORS
1. Pre-renal : involves decrease in GFR
(n=125ml/hr)

Hemorrhage

Shock

Chronic diarrhea (dehydration)

CHF

Hypotension

Septicemia
2. Intrarenal involves renal pathology

Pyelonephritis

DM

AGN

Acute tubular necrosis: common SE posthemolytic BT

3. Post-renal (+) mechanical obstruction

BPH

Nephro/urolithiasis

Tumor

Urinary strictures

Abejo

Medical and Surgical Nursing

Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
B.

STAGES
1.

2.

3.

V.

Oliguric phase passage of urine (1-2 weeks)

UO: <400 ml/cc

Hyperkalemia

Hypernatremia

Hyperphosphatemia

HYPOCALCEMIA

Hypermagnesemia

Metabolic acidosis

Elevated BUN, Crea

Diuretic Phase (2-3 weeks)

Increased passage of urine

Hyperkalemia

Hyponatremia

Metabolic acidosis
Convalescent phase (3-12 months)

Improvement in passage of urine

Characterized by complete diuresis

CHRONIC RENAL FAILURE (CRF) irreversible loss of

kidney function
A.

PREDISPOSING FACTORS
1. DM and HPN (common causes)
2. Recurrent pyelonephritis
3. Exposure to renal toxins
4. Tumor

B.

STAGES
1. Diminished renal reserve volume asymptomatic,
normal BUN and CREA
2. Renal insufficiency
3. End-stage renal disease (ESRD) presence of
oliguria, azotemia

C.

S/SX
1. Uro

Azotemia (elevated BUN and crea)

Oliguria

Nocturia

Hematuria

Dysuria
2. Neuro

Lethargy

Headache

Disorientation (initial sign of disequilibrium

syndrome) and confusion, restlessness

Memory impairment

Decreased LOC
3. Respi

Depressed or diminished cough reflex

Kussmauls respirations
4. Hema

Anemia

Leukopenia

Bleeding tendencies (thrombocytopenia)

All blood cells decreased

Increased susceptibility to infection

5. CV changes

Pulmo HPN

CHF

Pericarditis
6. GIT distress

7.

8.

9.

D.

NURSING MANAGEMENT
1. Enforce CBR
2. Admin oxygen inhalation as ordered
3. High CHO diet low CHON, fats, High vit and
minerals
4. Provide meticulous skin care

Wash with warm water

Soap irritates and dries skin

5. Meds as ordered

anti-HPN agents
Hydralazine (appresoline)
SE: orthostatic hypotension

NaHCO3

Kayexelate enema

Hematinics

Antibiotics

Supplementary vitamins and minerals

Phosphate binders

Calcium gluconate
6.

MS

Anorexia

N&V

Diarrhea and/or constipation

Stomatitis

Uremic breath
Integumentary

Pruritus

Uremic frost
Metabolic/Electrolyte imbalance

Hyperkalemia

Hyperphosphatemia

Metabolic acidosis
Endo

Gynecomastia

Hyperthyroidism

Assist in hemodialysis

Secure consent and explain procedure to client

Maintain strict aseptic technique
Obtain baseline data before and q30 during
procedure
VS
Wt
Blood exams secure all pre-procedure
I/O
Abejo

Medical and Surgical Nursing

Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN

MS

Have client void pre-procedure

Inform pt about bleeding (blood is heparinized)
Monitor for signs of complications
(BEDSSH)
Bleeding
Embolism
DISEQUILIBRIUM SYNDROME
results from rapid loss of nitrogenous
waste products particularly UREA from
the brain
HPN
Disorientation initial sign
Nausea and vomiting
anorexia
Headache
Paresthesia, peripheral
Numbness
Septicemia
Shock
Hepatitis
Avoid BP taking, phlebotomy, IV meds at the
site of fistula, blood extraction to prevent
compression
Maintain patency of shunt/fistula:
Palpate for thrills, auscultate for bruits
Instruct that minimal bleeding is expected
since blood is heparinized
Avoid use vasodilators, sedatives, and
tranquilizers to prevent hypotension unless
ordered
Prepare at bedside bulldog clips to prevent
embolism
Auscultate for bruits and palpate for thrills
(if (+) patent)
PERITONEAL DIALYSIS

7.

Most
common
complication
is
PERITONITIS and shock
First sign: cloudy dialysate return
Most
common
dialysate:
INFERSOL
Infusion time: 10-20 minutes
Dwelling time: 30-45 minutes

What determines effectiveness of dialysis?

Weight of patient

Assist
in
surgical
TRANSPLANTATION

procedure:

KIDNEY

Meds: steroids, immunosuppressants,

lymphocyte globulin

Feared complication: rejection, characterized

by
hypertension,
headache,
dizziness,
decreased CBC
2 TYPES OF REJECTION
Acute 6 to 10 months
Chronic 5-10 years
1. Oliguria
2. Disorientation
3. Decreased LOC

Abejo

anti

Medical and Surgical Nursing

Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN

MS

Abejo

Medical and Surgical Nursing

Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN

MS

Abejo